A Reporter’s Toolkit: Health Information Technology

An Alliance for Health Reform Toolkit - Produced with support from the Robert Wood Johnson Foundation

Tuesday, January 1, 2008

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The resources in this toolkit will help you understand how health information technology (IT) is slowly changing health care, and how analysts disagree about the value of some technologies. We offer you an introduction to issues such as protecting patient privacy and the cost of new technologies. This resource also offers story ideas, selected experts with contact information, selected websites of interest and a glossary.

Key Facts

Health information technology (IT) encompasses a broad array of technologies involved in managing and sharing patient information electronically, rather than through paper records.

Health IT has the potential to improve patient safety, health care quality, efficiency and data collection and may help restrain rising costs.

Adoption of health IT has generally been slow in the U.S. For example, while one in four doctors reports using electronic health records (EHRs), fewer than one in ten is using a “fully operational” system. 1

An important challenge for health IT is its cost: who should pay? Providers are expected to bear most of the cost of implementation, while much of the savings accrue to others – insurers, patients and governments.

Another challenge is protecting patient privacy. Once confidential patient information has been stored electronically, only those with a legitimate need to know should have access to it.

Selected Resources

Please email info@allhealth.org if you find that any of the links mentioned in this toolkit no longer work.

Story Ideas

What types of health IT have been adopted by local hospitals and physician groups in your area? At what cost? Has use of these technologies improved services and the quality of care received?

How do patients in your area feel about health IT? Do they have privacy concerns related to widespread use of electronic patient records? What are administrators and providers doing to allay these concerns?

Are providers in your area worried that storing patient data digitally will increase their risk of lawsuits?

Are there any local initiatives sponsoring the adoption of health IT in your area? Who is paying for the upfront costs involved?

Do regulations, such as those regarding prescription writing, stand in the way of health IT adoption in your state?

Are local companies involved in developing new health information technologies?

If you have a veterans hospital in your area, to what extent has the VA’s use of health IT improved care there?

According to stakeholders and consumer advocates in your area, what parts of health IT should remain at the regional or local level, and what parts should be integrated at the national level?

Are local or state public health agencies using IT to track or detect disease outbreaks? If so, are their efforts succeeding?

Glossary on Health Information Technology

CARRIER – An entity which may underwrite or administer a range of health benefit programs. May refer to an insurer or a managed health plan.

AMERICAN HEALTH INFORMATION COMMUNITY (AHIC) – A federally chartered advisory committee that makes recommendations to the secretary of the U.S. Department of Health and Human Services on how to make health records digital and interoperable, encourage market-led adoption and ensure that the privacy and security of those records are protected at all times.

COMMISSION ON SYSTEMIC OPERABILITY – Authorized by the Medicare Modernization Act of 2003, the commission was charged with developing strategies to make healthcare information instantly accessible at all times, by consumers and their healthcare providers. The group’s 12 recommendations and a discussion of the benefits of an interoperable network and the barriers to creating such a network were published in 2005 in a report “Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Technology” (http://endingthedocumentgame.gov).

COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) – A computerized system that allows a physician’s orders for services such as medications, laboratory tests and other tests to be entered electronically instead of being recorded on order sheets or prescription pads. This allows for the order to be compared against standards for dosing and to be checked for any patient allergies or interactions with other medications, or other potential problems if the order is filled.

CONNECTIVITY – The physical network and operating rules allowing computerized health information to be stored at one point and retrieved at another by an authorized user. For some people in the health IT field, connectivity implies having uniform privacy laws protecting individually identifiable medical information from be accessed by unauthorized persons.

ELECTRONIC HEALTH RECORD (EHR) – In health informatics, an electronic health record refers to the subset of a patient’s electronic medical record (EMR) that is integrated into a larger information network and owned by the patient. In common usage, EHRs and EMRs are used interchangeably to refer to a patient’s medical record in digital format. Efforts are underway to develop consensus definitions for these terms and others. See definitions.nahit.org/ for more information. See “fully operational electronic health record system.” Contrast with “electronic medical record” and “personal health record.”

ELECTRONIC MEDICAL RECORD (EMR) – An electronic medical record refers to a patient’s legal medical record, stored in digital format. It serves as a repository for clinical data and may have additional capacities such as computerized physician order entry (CPOE) and clinical decision support. Efforts are underway to develop consensus definitions for this term and others. See definitions.nahit.org/ for more information. See “fully operational electronic health record system.” Contrast with “electronic health record” and “personal health record.”

HEALTH INFORMATION EXCHANGE (HIE) – Health information exchange is defined as the mobilization of healthcare information digitally across organizations within a region or community. HIE provides the capability to move clinical information between separate health care information systems while maintaining the meaning of the information being exchanged.

HEALTH INFORMATION TECHNOLOGY (HIT) – Information processing using both computer hardware and software for the entry, storage, retrieval, sharing, and use of health care information. Two common components of HIT are electronic medical records and computerized physician order entry.

INTEROPERABILITY – The ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.

NATIONAL HEALTH INFORMATION NETWORK (NHIN) – The technologies, standards, laws, policies, programs and practices that enable health information to be shared among health decision makers, including consumers and patients, to promote improvements in health and health care. The vision for the NHIN is said to have begun in 1991 with the publication of an Institute of Medicine report, “The Computer-Based Patient Record.” The path to a national network of health care information is through the successful establishment of regional health information organizations.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY (ONC) – Provides counsel to the secretary of the U.S. Department of Health and Human Services and others within the department for the development and nationwide implementation of an interoperable health information technology infrastructure. The ONC also provides management of and logistical support for the American Health Information Community (AHIC).

PERSONAL HEALTH RECORD (PHR) – A PHR is a health record that is “owned” and maintained by an individual patient, rather than by payers or providers. Though the term has been around for several decades, it has recently received renewed attention with the adoption of electronic health records.

REGIONAL HEALTH INFORMATION ORGANIZATION (RHIO) – A RHIO is a multi-stakeholder organization, operating in a specific geographical area, that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency. Officials from the U.S. Department of Health and Human Services see RHIOs as the building blocks for the National Health Information Network (NHIN). When complete the NHIN will provide universal access to electronic health records.

9 The Office of the National Coordinator of Health Information Technology (ONC) recently hired the National Alliance for Health Information Technology (NAHIT) to lead an effort to reach consensus definitions for the following terms: electronic health record (EHR), electronic medical record (EMR), personal health record (PHR), regional health information organization (RHIO), and health information exchange (HIE). More information about this project, which is set to conclude in March 2008, can be found here: definitions.nahit.org/

10 David Blumenthal and John Glaser, “Information Technology Comes to Medicine,” The New England Journal of Medicine Vol. 356:24, June 14, 2007.

11 D.W. Bates et al., “Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors.” Journal of the American Medical Association 280:15 (1998): 1311-1316. Abstract available at: jama.ama-assn.org/cgi/content/abstract/280/15/1311 Retrieved September 20, 2007.

20 A.K. Jha et al., “Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care,” New England Journal of Medicine 348:22 (29 May 2003). Abstract available at:content.nejm.org/cgi/content/abstract/348/22/2218 Retrieved September 20, 2007.